PURPOSE: We report the occurrence and outcome of a severe late-onset traumatic dislocation of a laser in situ keratomileusis (LASIK) flap with loss of central flap tissue. METHODS: Case report. RESULTS: A 40-year-old woman underwent uncomplicated bilateral LASIK surgery, followed 5 years later by an enhancement procedure in both eyes. Ocular trauma with a power sander occurred 6 years after LASIK and 1 year after the enhancement procedure. The flap was found to have an almost complete tear from the nasal hinge and a central tissue defect. After irrigating, repositioning, and stabilizing the flap with 2 nylon sutures, a bandage contact lens was placed. The patient was treated with topical antibiotic and steroid drops. Stage 2 diffuse lamellar keratitis developed, which responded to topical treatment. Ten weeks after injury, the patient regained an uncorrected visual acuity of 20/20-1. CONCLUSION: Late-onset trauma to the LASIK flap can result in flap dehiscence and tissue loss. Prompt and appropriate management can lead to an excellent visual outcome even in severely traumatized dislocated LASIK flaps.

ABSTRACT
Purpose: We report the occurrence and outcome of a severe late-onset traumatic dislocation of a laser in situ keratomileusis (LASIK) flap with loss of central flap tissue.
Methods: Case Report.
Results: A 40-year-old woman underwent uncomplicated bilateral LASIK surgery, followed five years later by an enhancement procedure in both eyes. Ocular trauma with a power sander occurred six years after LASIK and 1 year after the enhancement procedure. The flap was found to have an almost complete tear from the nasal hinge, as well as a central tissue defect. After irrigating, repositioning and stabilizing the flap with two nylon sutures, a bandage contact lens was placed. The patient was treated with topical antibiotic and steroid drops. Stage II diffuse lamellar keratitis developed, which responded to topical treatment. Ten weeks after the injury, the patient regained an uncorrected visual acuity of 20/20-1.
Conclusion: Late-onset trauma to the LASIK flap can result in flap dehiscence and tissue loss. Prompt and appropriate management can lead to an excellent visual outcome even in severely traumatized dislocated LASIK flaps.